Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): a cluster-randomised controlled trial and cost-consequence analysis

Abstract

Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): a clusterrandomised controlled trial and cost-consequence analysis John L Campbell, Emily Fletcher, Nicky Britten, Colin Green, Tim A Holt, Valerie Lattimer, David A Richards, Suzanne H Richards, Chris Salisbury, Raff Calitri, Vicky Bowyer, Katherine Chaplin, Rebecca Kandiyali, Jamie Murdoch, Julia Roscoe, Anna Varley, Fiona C Warren, Rod S Taylor SummaryBackground Telephone triage is increasingly used to manage workload in primary care; however, supporting evidence for this approach is scarce. We aimed to assess the eff ectiveness and cost consequences of general practitioner-(GP)-led and nurse-led telephone triage compared with usual care for patients seeking same-day consultations in primary care.

GPs’ perceptions of workload in England: a qualitative interview study

“…25 However, recent evidence suggests this is not effective. 26 In 2015, a Primary Care Workforce Commission was established to identify models of primary care to meet the needs of the future as part of a 'New deal for general practice' and a '10-point plan' for recruitment and retention of GPs. 6 The report in July 2015 laid out recommendations, including restructuring of primary care services.…”

Using alternatives to face-to-face consultations: a survey of prevalence and attitudes in general practice

“…31 This research identified that some responders felt the need to resist a perceived pressure to adopt alternative approaches to consultations that have been claimed to have a potentially transformative impact on general practice. 5 This is despite proposed advantages in terms of access and resource use, 29 particularly as the use of the web, telephone, or text would be a natural development based on their use in other spheres of life. 32 The free-text responses revealed concerns about the perceived risks to patients, the organisation, and practice staff.…”

“…Several initiatives utilising information and communications technologies have been introduced with a view to reducing GP workload; for example, telephone triage. 5 A recent document outlining government proposals 6 suggested that the introduction of alternative methods to provide consultations, such as email or internet video (for example, Skype ™ ), could improve the current provision of primary care in the UK. The Prime Minister's Challenge Fund (PMCF) has provided financial incentives to implement such technologies in England.…”

The future of primary care? Reflections on the Primary Care Workforce Commission report

“…Nuanced histories and examination cannot be reliably achieved through triage, with the result that pre-consultation segregation by presenting problem may put comprehensive and skilled assessment at risk, as well as limiting patients' choice of available healthcare provider and continuity of care. 11,12 This model leads to further questions about responsibility; the report is silent on the question of who bears ultimate responsibility for independent work delivered by the extended primary care team. On the wider objective of providing 'challenging and satisfying careers' it remains unclear how well prepared the existing or future GP workforce will be for a role that concentrates on clinical complexity and supervisory duties, while removing cases that can be readily diagnosed and resolved.…”